Provider First Line Business Practice Location Address:
751 SAPPINGTON BRIDGE RD
Provider Second Line Business Practice Location Address:
MISSOURI BAPTIST HOSPITAL-SULLIVAN
Provider Business Practice Location Address City Name:
SULLIVAN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63080-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-468-1348
Provider Business Practice Location Address Fax Number:
573-468-1125
Provider Enumeration Date:
04/28/2008